Patient’s name: Connor O’Sullivan
Age: : 4years, 2 months old male
Past Medical History
Drug history
Missed routine appointment with Nurse for MMR vaccine (2nd dose) and 4-in-1 pre-school booster vaccine scheduled over 9 months ago- 2 text messages sent.
3 weeks ago–Seen by Kate Walsh (Nurse Access role):
MMR vaccine (2nd dose) administered. Advised to book another separate appointment for 4-in-1 pre-school booster.
Letter from Child Therapy unit–Did not attend paediatric physiotherapist appointment for in-toeing scheduled 2 weeks ago. Patient discharged back to GP –for GP to resend referral if still needed.
Mother- Siohban Hughes—booked appointment to discuss issues.
Patient’s Story – Siobhan (Mother of Connor)
You are Siobhan, the mother of Connor (4-years, 2 months-old male). You’re calling today because the health visitor who saw Connor yesterday advised you to contact the GP.
Connor developed right ear pain two days ago. Yesterday, you noticed a yellowish discharge coming from that ear. He also has a fever.
You gave him Calpol, thinking it was just a viral infection, but the health visitor felt he may need antibiotics and recommended you speak to a doctor.
Connor is otherwise drinking, eating, and passing urine normally. He seems generally well in himself aside from the ear symptoms.
If asked about any other symptoms (e.g. rash, sore throat, vomiting, balance issues), say NO.
You are a single mother, currently at work. Connor is with your parents, but they can’t bring him to the surgery—they don’t drive, and your mum is also caring for your dad, who has dementia.
You also have an 8-year-old child who is in school and doing fine.
PBIND (Pregnancy, birth, immunisation nutrition, development) history:
• Pregnancy & birth: Normal vaginal delivery, no complications.
• Immunisations: Not fully up to date
• Nutrition & development: Eating well, growing normally, developmentally on track
If the doctor asks why Connor is behind on his vaccinations, explain that you’re trying your best, but it’s sometimes difficult to arrange appointments due to your work schedule and the need to coordinate with your mum, who helps with childcare.
Connor’s father is not involved in their lives.
Ideas: You suspect it’s an ear infection.
Concerns: You’re worried because his symptoms haven’t improved, and the health visitor said he may need antibiotics.
Expectations: You’re hoping the GP can prescribe antibiotics.
Follow whatever advice the doctor gives.
History taking
Explain to the mum as below:
Siobhan, thank you for calling in today — I understand how busy things must be for you, and I really appreciate you taking the time to discuss Connor’s symptoms. You’ve done the right thing by reaching out, especially after the health visitor’s advice.
From what you’ve described — ear pain, fever, and yellowish discharge from his right ear — it sounds very much like a middle ear infection, known as otitis media. It’s quite common in young children and often follows a cold or congestion. The fact that there’s now discharge suggests that the eardrum may have burst slightly, which can relieve the pressure and pain — that’s quite typical and usually heals on its own.
Given that it’s been over 48 hours and there’s discharge along with fever, I think it would be reasonable to start antibiotics. I can send a prescription for you to collect — you should start the course straight away. Make sure he continues to drink plenty of fluids and you can also give paracetamol or ibuprofen to help with fever and pain.
If Connor’s symptoms don’t improve within the next couple of days, or if they get worse — especially if he develops swelling or redness behind the ear, becomes unusually drowsy, or is not passing urine as usual — please let us know immediately or call 111 or 999, depending on the situation.
I’d also like to see Connor in person, if possible, just to check his ears and general health — but I completely understand that you’re at work, and your parents can’t bring him in today. We can arrange a follow-up in 2–3 days, either by phone or face-to-face, depending on what works best for you.
I also noticed from our records that he missed his 4-in-1 preschool booster, and there was a missed physiotherapy appointment for his in-toeing. These things are important, and I understand that juggling work and caring for two children on your own is challenging. But to make sure Connor’s health needs are fully met, it’s really important that we try not to miss appointments where possible. If things ever feel overwhelming, please don’t hesitate to speak to us, we can offer support or refer you to services that help parents manage in difficult situations.
Let’s get a new referral to the physiotherapy team arranged for you, and I’ll also ask our reception team to help you book Connor’s missed vaccinations — we want to make sure he’s fully protected.
Finally, I’ll document everything we’ve discussed and arrange that prescription now. Would you prefer to pick it up from the pharmacy directly or from the surgery?
Management
Learning Point from This Station
This station highlights the importance of clinical flexibility and empathy when managing unwell children in a remote consultation — especially when practical barriers (like childcare, transport, or work pressures) prevent in-person attendance.
It reinforces the need to:
It also underlines the GP’s role in promoting continuity of care, especially for children who have missed vaccinations or therapy appointments, and the importance of gentle but firm communication when supporting single parents — balancing empathy with a reminder of the child’s ongoing health needs.
If missed appointments persist despite support, safeguarding may need to be considered to ensure the child’s wellbeing is not compromised.